We must be doing something wrong...

[johnmendes]

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Someone said above that PAs and NPs are essential in medicine. Seriously? Look at europe, we don't have those and seem to be doing pretty well.

 

[phltz]

you cannot necessarily know ahead of time which are the easy cases. THAT is the whole point. The hardest cases do not come with a sign hung round their necks saying so

So your argument is that it's better to always bring out the biggest guns possible at the outset (meaning someone with the most complete training), just in case it turns out to be necessary? So where does it end? Should we replace school nurses with school doctors? Should an ambulance always show up with a doctor in it instead of paramedics? Maybe when you buy a box of bandaids at CVS, there'll be a miniature doctor inside, waiting to pop out and inspect your minor cuts before you put the bandaids on?

I (and I think the great majority of other people) am willing to run the incredibly miniscule risk that a mid-level practitioner will miss the fact that my post-camping-trip giardia is actually covering up a more serious problem, if it means I can get an appointment sooner and cheaper.

 

[SpecterGT260]

So your argument is that it's better to always bring out the biggest guns possible at the outset (meaning someone with the most complete training), just in case it turns out to be necessary? So where does it end? Should we replace school nurses with school doctors? Should an ambulance always show up with a doctor in it instead of paramedics? Maybe when you buy a box of bandaids at CVS, there'll be a miniature doctor inside, waiting to pop out and inspect your minor cuts before you put the bandaids on?

I (and I think the great majority of other people) am willing to run the incredibly miniscule risk that a mid-level practitioner will miss the fact that my post-camping-trip giardia is actually covering up a more serious problem, if it means I can get an appointment sooner and cheaper.

Nope... outlining the ins and outs of an argument is not the same as taking a stance. I've said several times that this is a trade off. Im just saying we cannot act like there isn't a down side. Whether it is worth it or not is a different discussion 😉

 

[C5toC9]

Do NPs who basically run independent practices bill the same as the MD in a same practice? I've seen clinics where they literally do the same things, but I never knew if their income/billing/charge to the patient was the same.

 

[Socrates25]

I think part of the reason is when MD's start saying stuff like they don't want to see "easy" cases or that benign regular stuff is a "waste" of their time. This is where midlevel providers are creeping in, and the problem will only get worse because there is no limit. As was mentioned already, "easy" cases is a very subjective term.

In every other country outside the US, there are no PAs or NPs who see patients independently and act as MDs. It would be totally ridiculous to suggest to patients. When you start saying things are a waste of your time, you are basically inviting the midlevels to take over your jobs.

This is the smartest thing I've heard a med student say in quite some time. Bravo!

 

[Morsetlis]

Someone said above that PAs and NPs are essential in medicine. Seriously? Look at europe, we don't have those and seem to be doing pretty well.

To be fair, Europe does not have a problem with having to pay physicians $250k+ / year either... the PA and NP thing is a cost-saving measure due to the scarcity and cost of physicians within the US. That, plus they have really good professional lobbying.

 

[eagle34]

To be fair, Europe does not have a problem with having to pay physicians $250k+ / year either... the PA and NP thing is a cost-saving measure due to the scarcity and cost of physicians within the US. That, plus they have really good professional lobbying.

Look at the proportion of PCPs in any other country than US. In europe, it's around 50%. In the UK, it's almost 67%. PA/NPs were meant to fill the gap in primary care. Except that many of PAs are specializing now too since the pay is much better than in primary care.

 

[eagle34]

Do NPs who basically run independent practices bill the same as the MD in a same practice? I've seen clinics where they literally do the same things, but I never knew if their income/billing/charge to the patient was the same.

I'm pretty sure that PA/NPs have their own billing codes that are different than MDs.

 

[Shnurek]

Someone said above that PAs and NPs are essential in medicine. Seriously? Look at europe, we don't have those and seem to be doing pretty well.

Except, here in America PAs get paid the same as your MDs basically. ~2x the average income.

 

[eagle34]

Except, here in America PAs get paid the same as your MDs basically. ~2x the average income.

PAs in a specialty maybe get paid around what primary care MDs get. No way to PAs in primary care get paid same as primary care MDs. And no way to PAs in specialty get paid anywhere close to what MDs get paid in specialty.

 

[SpecterGT260]

From another thread in here the difference in pay between primary and specialty isn't outrageous... 280k to 350k or something? Average values... What % of PAs break 200k?

 

[eagle34]

From another thread in here the difference in pay between primary and specialty isn't outrageous... 280k to 350k or something? Average values... What % of PAs break 200k?

I have no exact statistics, but my guess is that its probably like 0.01%. I think a PA with like 10-15 years of experience will earn around $120k in an orthopedic private practice.

 

[CodeBlu]

(I’m really sorry for hi-jacking this thread)

Shnurek,

I’ve been noticing your posts on a variety of issues for a couple of months now. I generally enjoy reading your insights and think you’re a great contributor. However, I’ve noticed that this idea (RE: medical students are too old in this country because their fluid intelligence is past its prime, and this is the root of a lot of problems) is something of a pet interest for you. You seem to bring it up a lot. And as much as I respect your other contributions I’m finally going to call you out on this. I think you are over-reaching and extrapolating data way too much.

First off, your primary source in in this post is “highiqpro.com”. Looking into that website it appears to be a site that sells an IQ-improvement regimen. Not that a biased information source alone is enough reason to discount the information they present (because some of it is true), but the fact that it’s coming from a commercial, totally non-peer-reviewed source adds a bit of skepticism right off the bat.

Yes, it is true that average fluid intelligence (Gf) decreases gradually after full adulthood is reached. Yes, it is true that Gf can be improved with mental exercise and practice. The end. That’s really the extent of the data right there. Anything beyond that is extrapolation.

So here are a few reasons I’m pulling the BS-flag on the “med school/residency should start at a younger age” idea:

1 - There have been no studies, that I’m aware of, that look at Gf in medical students and residents explicitly. You’ve got to separate them from the general populace. Most average people are done with formal education by their mid-20s and your average job doesn’t require an excessive amount of Gf use, but rather relies on the execution of memorized protocols. Thus, perhaps the peak age of Gf is significantly higher for med students or others (like yourself) who are pursuing advanced education.

2 - According to the graph you posted from that commercial website, giving it the benefit-of-the-doubt and assuming it to be accurate for a moment, the “peak” doesn’t really seem to drop off significantly until the average person’s mid-30s. This leads me to suspect that, even if everything else you’re saying is right, the effects of having slightly older medical students/residents are far less exaggerated than you’re making them out to be.

3 - The science that you are basing your assumptions on actually weakens your argument. If Gf tends to decrease with age, and if Gf can be improved with training, than isn’t it possible that the rigorous critical thinking involved in medical education could actually increase Gf? Or at least “cancel-out” the deleterious effects of aging?

4 - This, to me, the most important thing… even if you are totally correct in all your assumptions, is having a marginally higher Gf at the time of medical training really worth the potential trade-offs in maturity, emotional and social competency, and overall “well-roundedness” that a slightly (we’re talking 2-3 years here…) older and more seasoned medical student/resident brings to the table?

5 - There is a huge, glaring gap between where the science ends and where you propose that medical education occurs at a suboptimal age. There is an even HUGER and 1000 times wider gap between that presumption and the notion that midlevel providers (or ODs, since you brought it up) are able to match physicians' level of expertise because, even though they trained for less time, they got more “bang for their buck” because they were a few years younger. I mean really?? Is that really the argument you wanted to make? Because that’s what your concluding paragraph suggests.

For those interested, here are the nuts and bolts of the actual evidence on these matters:

(Jaeggi, Buschkuehl, Jonides, & Perrig, 2008)



(Feiyue, Qinqin, Liying, & Lifang, 2009)



(Tranter & Koutstaal, 2008)





Feiyue, Q., Qinqin, W., Liying, Z., & Lifang, L. (2009).Study on Improving Fluid Intelligence through Cognitive Training System Based on Gabor Stimulus. Paper presented at the 1st International Conference on Information Science and Engineering (ICISE).

Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Perrig, W.J. (2008). Improving fluid intelligence with training on working memory. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.]. Proc Natl Acad Sci U S A, 105(19), 6829-6833.doi: 10.1073/pnas.0801268105

Tranter, L. J., & Koutstaal, W. (2008). Age and flexible thinking: an experimental demonstration of the beneficial effects of increased cognitively stimulating activity on fluid intelligence in healthy older adults.[Randomized Controlled Trial Research Support, Non-U.S. Gov't]. Neuropsychol Dev Cogn BAging Neuropsychol Cogn, 15(2), 184-207. doi: 10.1080/13825580701322163

Owned. Love it. 😱

 

[Shnurek]

PAs in a specialty maybe get paid around what primary care MDs get. No way to PAs in primary care get paid same as primary care MDs. And no way to PAs in specialty get paid anywhere close to what MDs get paid in specialty.

1) do
2) I was talking about PAs in America making 2x the average salary of an American worker. ~2 X 48,000 or whatever it is now = 96,000. And I was comparing this to MDs in Europe that also make 2x the average salary of a worker there. BUT their schooling is subsidized.

So I was expanding this point:

To be fair, Europe does not have a problem with having to pay physicians $250k+ / year either... the PA and NP thing is a cost-saving measure due to the scarcity and cost of physicians within the US. That, plus they have really good professional lobbying.

 

[Shnurek]

Owned. Love it. 😱

He didn't really disprove my point. He just proved with his citations that high levels of fluid intelligence can be retained into older age. My point still stands that being trained in basically anything at a younger age is better because our brains are more malleable the younger we are.

Those people that are trained younger and also retain high levels of fluid intelligence at an older age are better off than those people that are trained older and also retain high levels of fluid intelligence at an older age because more of their long term crystallized intelligence is dedicated to what they are trained in.

http://www.examiner.com/parenting-t...me-16-year-old-develops-new-surgery-technique

 

[JackShephard MD]

If I can chime in...

The problem with medical education in America is that it is indeed inefficient. It starts too late in life. We should specialize at a younger age. Why? You may ask.

If you have taken neuroscience 101 you would know that the brain is most neuroplastic when it comes to fluid intelligence and processing ability at around age 26. After all Albert Einstein published his Theories of General and Special Relativity at age 26 for example.

Notice this chart:

Fluid intelligence (Gf)
Processing speed (Gs)
Crystallized intelligence (Gc)
Source: http://www.highiqpro.com/iq-cognitive-health-aging/the-5-factors-of-intelligence-over-the-lifespan

Fluid intelligence and processing speed peak at around age 26. Crystallized intelligence goes on and lingers a lot longer because it is made up of facts and life experiences we have had.

So now onto my point: Medical education should start sooner by at least 2 years if not 4. Have direct programs to enter the medical college. Almost every other foreign nation graduates their MDs by age 21 or so. This way at age 21 and for the next 5-8 years or so the residents are exposed to the most critical part of their training during the time they are the most cognitively proficient.

Early specialization is just more efficient plain and simple. Having students graduating at age 26 with an MD and having to go through another 3-8 years of residency after they have passed their peak is just not the best way to go about it. If something is not done to change things, midlevels will just keep creeping up because a lot of them are trained at a younger age and it is more intuitive for them. Notice my profession for example. We have only 4 years of eye school and we can do laser eye surgery in 2 states at age 26 and prescribe oral medications in 47/50 states. Why? Because we specialize at the critical period and we know what we are doing. Its not about increasing training time to 3 decades. Its about getting trained at the right time.

(I'm really sorry for hi-jacking this thread)

Shnurek,

I've been noticing your posts on a variety of issues for a couple of months now. I generally enjoy reading your insights and think you're a great contributor. However, I've noticed that this idea (RE: medical students are too old in this country because their fluid intelligence is past its prime, and this is the root of a lot of problems) is something of a pet interest for you. You seem to bring it up a lot. And as much as I respect your other contributions I'm finally going to call you out on this. I think you are over-reaching and extrapolating data way too much.

First off, your primary source in in this post is "highiqpro.com". Looking into that website it appears to be a site that sells an IQ-improvement regimen. Not that a biased information source alone is enough reason to discount the information they present (because some of it is true), but the fact that it's coming from a commercial, totally non-peer-reviewed source adds a bit of skepticism right off the bat.

Yes, it is true that average fluid intelligence (Gf) decreases gradually after full adulthood is reached. Yes, it is true that Gf can be improved with mental exercise and practice. The end. That's really the extent of the data right there. Anything beyond that is extrapolation.

So here are a few reasons I'm pulling the BS-flag on the "med school/residency should start at a younger age" idea:

1 - There have been no studies, that I'm aware of, that look at Gf in medical students and residents explicitly. You've got to separate them from the general populace. Most average people are done with formal education by their mid-20s and your average job doesn't require an excessive amount of Gf use, but rather relies on the execution of memorized protocols. Thus, perhaps the peak age of Gf is significantly higher for med students or others (like yourself) who are pursuing advanced education.

2 - According to the graph you posted from that commercial website, giving it the benefit-of-the-doubt and assuming it to be accurate for a moment, the "peak" doesn't really seem to drop off significantly until the average person's mid-30s. This leads me to suspect that, even if everything else you're saying is right, the effects of having slightly older medical students/residents are far less exaggerated than you're making them out to be.

3 - The science that you are basing your assumptions on actually weakens your argument. If Gf tends to decrease with age, and if Gf can be improved with training, than isn't it possible that the rigorous critical thinking involved in medical education could actually increase Gf? Or at least "cancel-out" the deleterious effects of aging?

4 - This, to me, the most important thing… even if you are totally correct in all your assumptions, is having a marginally higher Gf at the time of medical training really worth the potential trade-offs in maturity, emotional and social competency, and overall "well-roundedness" that a slightly (we're talking 2-3 years here&#8230😉 older and more seasoned medical student/resident brings to the table?

5 - There is a huge, glaring gap between where the science ends and where you propose that medical education occurs at a suboptimal age. There is an even HUGER and 1000 times wider gap between that presumption and the notion that midlevel providers (or ODs, since you brought it up) are able to match physicians' level of expertise because, even though they trained for less time, they got more "bang for their buck" because they were a few years younger. I mean really?? Is that really the argument you wanted to make? Because that's what your concluding paragraph suggests.

For those interested, here are the nuts and bolts of the actual evidence on these matters:

(Jaeggi, Buschkuehl, Jonides, & Perrig, 2008)



(Feiyue, Qinqin, Liying, & Lifang, 2009)



(Tranter & Koutstaal, 2008)





Feiyue, Q., Qinqin, W., Liying, Z., & Lifang, L. (2009).Study on Improving Fluid Intelligence through Cognitive Training System Based on Gabor Stimulus. Paper presented at the 1st International Conference on Information Science and Engineering (ICISE).

Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Perrig, W.J. (2008). Improving fluid intelligence with training on working memory. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.]. Proc Natl Acad Sci U S A, 105(19), 6829-6833.doi: 10.1073/pnas.0801268105

Tranter, L. J., & Koutstaal, W. (2008). Age and flexible thinking: an experimental demonstration of the beneficial effects of increased cognitively stimulating activity on fluid intelligence in healthy older adults.[Randomized Controlled Trial Research Support, Non-U.S. Gov't]. Neuropsychol Dev Cogn BAging Neuropsychol Cogn, 15(2), 184-207. doi: 10.1080/13825580701322163

The misconception here is: the more intelligent the individual, the better the physician.

Academics love to think this, as do pre-meds and med students. Ask any practicing physician of 10+ years, if the highest scoring students are the most successful physicians (however you might define success).

No doubt, a certain level of intelligence is necessary to engage in the field. Yet then many other factors take over to determine success.

 

[SpecterGT260]

currently "success" is measured by how much your patients like you. However that is only 1 definition of "better"

 

[SteinUmStein]

currently "success" is measured by how much your patients like you. However that is only 1 definition of "better"

Is it? I thought it was how many patients you can see in a day...

 

[SpecterGT260]

touché. Apparently I am falling into the indoctrination of our clinical lecturers 🤣

 

[JackShephard MD]

I know this is about sports, but what they're saying relates a lot to medicine and success:

[YOUTUBE]KxV-QshUWOU[/YOUTUBE]